Lions Hearing Aid Bank Application - Nebraska Commission for the - ncdhh ne 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out your personal information. Enter your last name, first name, middle name, gender, mailing address, city, state, zip code, county, email address, last four digits of your Social Security number, date of birth, and telephone number.
3. Proceed to the income information section. Input your gross monthly income and your spouse’s gross monthly income if applicable. Check the appropriate sources of income that apply to you.
4. Indicate whether you receive Medicaid and provide details about your living situation and dependents.
5. Answer questions regarding your current use of hearing aids and previous applications to the Lions Hearing Aid Bank.
6. Finally, sign the application certifying that all provided information is accurate. Don't forget to include the Citizenship Attestation Form before submission.

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